Cognitive inflexibility and over‐attention to detail: The Italian validation of the DFlex Questionnaire in patients with eating disorders

Abstract

Objective: Cognitive inflexibility and over-attention to detail are two cognitive styles common to eating disorders (ED) and other psychopathologies characterized by rigid perfectionism. Despite many options to assess the above styles, the only self-report tool that simultaneously permits their specific assessment is the Detail and Flexibility Questionnaire (DFlex), originally developed to investigate the ED domain. The aim of this study was to validate the Italian version of the DFlex. Method: 170 patients (149 females) with ED and 148 controls (100 females) completed the Italian version of the DFlex. Results: A Confirmatory Factor Analysis showed that the two-factor model originally proposed in the literature was a good fit to the data. Item factor loadings were largely equivalent across clinical and control groups, with intercept distributions showing higher values for the clinical group compared to controls. Both DFlex subscales showed good internal reliability and were able to predict membership to the group condition. Conclusions: The DFlex is a reliable tool for investigation in the ED population. However, because DFlex items do not explicitly assess food and body shape domains, it is possible to extend its use to other psychopathologies characterized by rigid perfectionism. We propose the use of the DFlex in research and clinical practice as a useful tool for better understanding patients' cognitive functioning and in order to support treatment planning.

Validating and developing a shortened version of the detail and flexibility (DFlex) questionnaire for eating disorders, anxiety and depression

“…Results concerning the convergent validity of the two DFlex versions in Part 2 were mixed. The DFlex and DFlex-Revised cognitive rigidity subscales demonstrated significant positive associations with the AQ-attention switching subscale, which is consistent with the findings of the previous studies by Maria et al (2020), Marchiol et al (2020), and Roberts et al (2011). The consistent findings between the original DFlex and DFlex-Revised cognitive rigidity scales lend support to the validity of the revised subscale developed in the current study.…”

“…The findings of Part 1 did not support the a priori two factor structure of the original DFlex (Roberts et al., 2011) and contrast with Marchiol et al. (2020) whose CFA of the Italian DFlex supported this factor structure. It is unclear why the results of our factor analyses failed to provide support for the original factor structure of the DFlex.…”

“…To date, only two studies have sought to validate the DFlex cross-culturally. Marchiol et al (2020) conducted Confirmatory Factor Analysis (CFA) for the Italian version of the DFlex across ED (n = 170) and control (n = 148) samples. Their results supported the factor structure proposed by Roberts et al (2011) in both groups.…”

“…Second, the DFlex may demonstrate utility in psychiatric disorders which are characterised by maladaptive perfectionism and cognitive inflexibility, such as anxiety and depression (Marchiol et al., 2020; Snyder et al., 2015). Similarly, no study to date has examined the factor structure of the DFlex in clinical populations other than EDs or made comparisons between ED and other clinical populations on the DFlex.…”

Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit

“…Higher scores indicate higher cognitive resistance to change. Cronbach's α = 0.793. Detail and Flexibility Questionnaire (DFlex): the DFlex is a 24‐item self‐related scale designed to assess cognitive rigidity and attention to detail and is a well‐established tool for evaluating CRT treatment (Marchiol et al., 2020; Roberts et al., 2011). The clinical cut‐off for the cognitive rigidity subscale is 53 and above, and for the attention to detail subscale, it is 44.…”